Filip Claus

University of Leuven, Louvain, Flanders, Belgium

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Publications (81)268.97 Total impact

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    ABSTRACT: Lung hypoplasia in congenital diaphragmatic hernia (CDH) is a life-threatening birth defect. Severe cases can be offered tracheal occlusion to boost prenatal lung development, though defining those to benefit remains challenging. Metabonomics of 1H NMR spectra collected from amniotic fluid (AF) can identify general changes in diseased versus healthy fetuses. AF contains lung secretions, hence, might reflect pulmonary characteristics among general markers of disease in CDH fetuses. AF from 81 healthy and 22 CDH fetuses was collected. NMR spectroscopy was performed at 400 MHz to compare AF from fetuses with CDH against controls. Several advanced feature extraction methods based on statistical tests which explore spectral variability, similarity and dissimilarity were applied and compared. This resulted in the identification of 30 spectral regions, which accounted for 80% variability between CDH and controls. Combination with automated classification discriminates AF from CDH versus healthy fetuses with 86% accuracy. Within the identified spectral regions isoleucine, leucine, valine, pyruvate, GABA, glutamate, glutamine, citrate, creatine, creatinine, taurine and glucose were the most concentrated metabolites. As the metabolite pattern of AF changes with fetal development, we have excluded metabolites with a high age-related variability and repeated the analysis with twelve spectral regions, which has resulted in similar classification accuracy. From this analysis, it was possible to distinguish between AF from fetuses with CDH from healthy controls independent of gestational age dependent metabolic changes.
    No preview · Article · Sep 2015 · Journal of Proteome Research
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    ABSTRACT: To assess in vivo changes in lung and liver volume in fetuses with isolated congenital diaphragmatic hernia (CDH), either expectantly managed or treated in utero. This is a secondary analysis of prospectively collected data at 2 fetal therapy centers. We used archived magnetic resonance (MR) images of fetuses taken ≥7 days apart, creating paired observations in 20 expectantly managed cases, 41 with a second MR prior to balloon reversal and 64 after balloon removal. We measured observed to expected total fetal lung volume (O/E TFLV) and liver-to-thoracic volume ratio (LiTR). We calculated changes in volume as compared to the initial measurement and its rate as a function of gestational age (GA) at occlusion. The LiTR did not change in either group. In expectantly managed fetuses, O/E TFLV did not increase with gestation. In fetuses undergoing tracheal occlusion (TO) the measured increase in volume was 2.6-times larger with balloon in place as compared to after its removal. GA at TO was an independent predictor of the O/E TFLV. The net rate seems to initially increase and plateau at a maximum of 1.5%/week by 35-45 days after occlusion. TO induces a net increase in volume, its magnitude essentially dependent on the GA at occlusion. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2015 · Prenatal Diagnosis
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    ABSTRACT: We studied the correlation between prenatal diagnosis and postmortem investigations in pregnancies terminated for renal malformations. Over a 5-year period, 77 cases of termination of pregnancy (TOP) for renal malformations were reviewed. Chromosomal anomalies (n = 9) and cases without conventional or virtual autopsy were excluded (n = 15). In 53 cases, prenatal ultrasound diagnosis and conventional autopsy findings were compared. In addition, we compared the accuracy of conventional and virtual autopsy findings in 17 cases. Full agreement was observed in 60.4 % (32/53) of cases. In 26.4 % (14/53) of the cases, the presence of additional malformations did not alter the final diagnosis. However, in 11.3 % (6/53) the final diagnosis was adjusted because of major additional findings. One case showed a total disagreement. Conventional and virtual autopsy were in full agreement in 52.9 % (9/17). Postmortem magnetic resonance imaging (MRI) description and detection of malformations was less complete and failed to correctly diagnose 5/17 cases (29.4 %). In 17.6 % (3/17) of the cases, postmortem MRI revealed malformations not confirmed by conventional autopsy. A high correlation between prenatal ultrasound and postmortem investigations was observed. Conventional autopsy remains the gold standard to reveal additional major and minor malformations, leading to a correct final diagnosis. The added value of virtual necropsy for renal pathology was limited.
    No preview · Article · Mar 2015 · Pediatric Nephrology
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    ABSTRACT: Our primary objective was to develop relevant algorithms for quantification of mesh position and 3D shape in magnetic resonance (MR) images. In this proof-of-principle study, one patient with severe anterior vaginal wall prolapse was implanted with an MR-visible mesh. High-resolution MR images of the pelvis were acquired 6 weeks and 8 months postsurgery. 3D models were created using semiautomatic segmentation techniques. Conformational changes were recorded quantitatively using part-comparison analysis. An ellipticity measure is proposed to record longitudinal conformational changes in the mesh arms. The surface that is the effective reinforcement provided by the mesh is calculated using a novel methodology. The area of this surface is the effective support area (ESA). MR-visible mesh was clearly outlined in the images, which allowed us to longitudinally quantify mesh configuration between 6 weeks and 8 months after implantation. No significant changes were found in mesh position, effective support area, conformation of the mesh's main body, and arm length during the period of observation. Ellipticity profiles show longitudinal conformational changes in posterior arms. This paper proposes novel methodologies for a systematic 3D assessment of the position and morphology of MR-visible meshes. A novel semiautomatic tool was developed to calculate the effective area of support provided by the mesh, a potentially clinically important parameter.
    No preview · Article · Mar 2015 · International Urogynecology Journal

  • No preview · Article · Jan 2015 · American Journal of Obstetrics and Gynecology
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    ABSTRACT: To investigate the natural history, associated abnormalities and outcome of 12 fetuses with arachnoid cyst diagnosed antenatally by ultrasound and magnetic resonance imaging and to compare the outcome with cases in the literature. A retrospective study of all cases of antenatally detected fetal arachnoid cysts was performed in patients referred to a tertiary unit between 2007 and 2013. Associated abnormalities, pregnancy outcome and postnatal follow-up were analyzed. All papers about prenatally diagnosed arachnoid cysts, of the last 30 years, were evaluated (search terms in Pubmed: "prenatal diagnosis", "Arachnoid Cysts"). Fetal arachnoid cysts were diagnosed in 12 fetuses, 9 were females. The mean gestational age of diagnosis was 28 1/7 (range 19 1/7-34 2/7 weeks). A total of 9 cases were supratentorial, 3 were located in the posterior fossa. In 10 cases a fetal MRI was performed which confirmed brain compression in 4 out of 5 supratentorial arachnoid cyst. MRI did not reveal other malformations nor signs of nodular heterotopia. Only one fetus presented with additional major anomalies (bilateral ventricumomegaly of >20 mm and rhombencephalosynapsis) leading to a termination of pregnancy. Two neonates underwent endoscopic fenestration of the arachnoid cyst in the first week of life with no additional intervention in childhood. All but one (10/11) had a favorable postnatal outcome. This child suffered from visual impairment at autism was diagnosed at the age of 5. One child had a surgical correction of strabismus later in childhood. In one child the infratentorial arachnoid cyst regressed spontaneously on ultrasound and MRI in the postnatal period. The majority of arachnoid cysts in this series are of benign origin and remain stable. Based on the current series and the review of the literature, in the absence of other associated anomalies and when the karyotype is normal, the postnatal overall and neurological outcome is favorable. Large suprasellar arachnoid cysts however, may cause visual impairment and endocrinological disturbances. Rarely associated cerebral or cerebellar malformations are present. Modern postnatal management of suprasellar arachnoid cyst consists of endoscopic cystoventriculostomy. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Dec 2014 · European journal of paediatric neurology: EJPN: official journal of the European Paediatric Neurology Society
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    ABSTRACT: Objective To determine the bias induced by matching fetuses by gestational age (GA) or by fetal body volume (FBV) when calculating the observed/expected total fetal lung volume (o/e TFLV) in isolated congenital diaphragmatic hernia (CDH). Methods Single-center, retrospective study on archived magnetic resonance (MR) images of isolated CDH fetuses over a 10-year's period. We retrieved the TFLV, GA and o/e TFLVGA, delineated FBV to obtain TFLVFBV. We correlated o/e TFLVFBV and o/e TFLVGA by Bland Altman analysis. All outliers were manually identified to retrieve specific clinical features. Results377 MR examinations from 225 fetuses were identified. The average time spent on FBV measurement was 16.12 ± 4.95 min. Reproducibility of FBV measurement was 0.998 and the interobserver intraclass correlation coefficient was 0.999. FBV was highly correlated with GA (R = 0.94, p < 0.0001). There was a good agreement between o/e TFLVGA or o/e TFLVFBV, with a mean difference = −1.10% and 95%-limits-of-agreement of −8.58 to 6.39. There were no outliers in fetuses that had an o/e TFLV<25%. Discrepancies induced by different methods were more likely in woman with BMI≥25 kg/m2 (+16.49%), fetuses with an estimated fetal weight (EFW)≤10th percentile (+21.33%) or EFW>90th percentile (+14.82%). Conclusions Discrepancies are more likely in fetuses with an abnormal EFW or in overweighted mothers. The clinical relevance of using FBV rather than GA for calculation of the o/e TFLV might be limited, as there was no discrepancy between both methods in fetuses with small lungs (<25%), the group of interest for lung volume assessment.
    No preview · Article · Dec 2014 · Ultrasound in Obstetrics and Gynecology
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    ABSTRACT: Objectives To assess the relationship between the position of the stomach and the volume of herniated organs into the thorax, and the observed-to-expected total fetal lung volume (o/e TFLV), which is a measure of pulmonary hypoplasia in fetuses with isolated left sided congenital diaphragmatic hernia (LCDH).Methods Single-center study on archived MR images of fetuses evaluated for isolated LCDH over an 11-year period. We retrieved the gestational age at MR examination, the o/e TFLV and liver position. Images were also reviewed to retrospectively determine the position of the stomach as well as the proportion of the volume of fetal liver, stomach and other viscera into the thorax, to the total thorax volume. The latter measurements were done by a single operator. Following confirmation of reproducibility, we correlated intra-thoracic organ volumes and stomach position to the o/e TFLV.Results205 fetuses underwent 259 MR examinations. The reproducibility of organ volume measurements was excellent (range of ICC: 0.928-0.997). The average time spent on each intra-thoracic organ volume ranged from 2.28-5.13 min. From all herniated organs, the liver-to-thoracic volume ratio (LiTR) correlated best to o/e TFLV (R = −0.429, p < 0.0001). Stomach volume did not correlate though as a categorical variable, the position of the stomach was inversely related to the o/e TFLV.Conclusions We observed an inverse relationship between lung volume and the amount of liver herniated as well as the position of the stomach into the chest.
    No preview · Article · Oct 2014 · Ultrasound in Obstetrics and Gynecology
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    ABSTRACT: Objective To report a recent update on fetuses with right-sided congenital diaphragmatic hernia (RCDH) in the era of fetal surgery.DesignRetrospective review of prospectively collected data.SettingFetal treatment centres in Leuven and Barcelona.PopulationConsecutive cases of RCDH between 2002 and 2012.Methods Data on prenatal imaging, genetic testing, pregnancy and neonatal outcomes were extracted from our databases, including structural and genetic anomalies, candidate outcome predictors such as lung size, liver herniation ratio, polyhydramnios, cervical length, preterm prelabour rupture of membranes and gestational age at birth.Main outcome measuresSurvival and oxygen dependency at discharge.ResultsTen out of 86 fetuses with RCDH had associated abnormalities. Of 76 isolated pregnancies, eight women opted for termination of pregnancy, most with severe hypoplasia and one was lost to follow up. Nineteen pregnancies were expectantly managed and delivered at a mean gestational age of 36.0 ± 3.0 weeks. Survival at discharge was 53% (10/19), one being oxygen dependent. In the fetal surgery group (n = 48), mean gestational age at delivery was 34.5 ± 3.0 weeks. In our recent experience not previously published (n = 23) survival rate was 52 and 39% were oxygen dependent at discharge. Pooling these data with earlier reported observations by our group we observed a 42% survival rate in 57 fetuses. Lung size on magnetic resonance imaging and an interval of >24 hours between reversal of tracheal occlusion and delivery were predictors of outcome.Conclusions Right-sided CDH seems to have a poorer outcome than that reported for fetuses with left-sided CDH with similar lung size before birth. Survival rates after expectant management with observed/expected lung-to-head ratio values ≤45 and ≤30% were 17 and 0%, respectively. In those undergoing fetal surgery (observed/expected lung-to-head ratio ≤45%) there was an apparent increase (42%).
    No preview · Article · Sep 2014 · BJOG An International Journal of Obstetrics & Gynaecology
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    ABSTRACT: Objectives The purpose of this study was to retrospectively assess the incidence of bowel wall oedema on computed tomography (CT) in patients with renal cell carcinoma (RCC) treated with sunitinib, and to investigate its association with diarrhoea. Methods We conducted a retrospective analysis of all RCC patients treated with sunitinib at our hospital between December 2005 and December 2011. The presence or absence of bowel wall oedema on these CT examinations was scored. The presence of diarrhoea preceding, during, or after sunitinib treatment was identified from the patient files and retrospectively graded. Results For 54 of 87 patients, bowel wall oedema was present on at least one CT examination. Of these 54 patients, the right-sided colonic segment was affected in 87 %. Diarrhoea was the most common reported adverse event during treatment, with 58 patients (67 %) having grade 1/2 diarrhoea and 9 patients (10 %) having grade 3. There was a statistically significant correlation between the incidence of CT-scored bowel oedema and diarrhoea during sunitinib treatment (P=0.004). Conclusions This study shows a very high incidence of bowel wall oedema and a strong correlation between the incidence of bowel wall oedema and diarrhoea in patients treated with sunitinib.
    Full-text · Article · Aug 2014 · European Radiology
  • L Bonne · M Bex · R Oyen · F Claus

    No preview · Article · May 2014 · JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)
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    ABSTRACT: Postmortem MRI (pmMRI) is increasingly used in perinatology, typically as an alternative or complement to conventional necropsy for central nervous system anomalies. Overall it provides reliable information on structural malformations, but was shown to be of limited use in examining fetal heart. We aimed to assess the fetal heart on 3-Tesla pmMRI in a consecutive series of fetuses with structural congenital heart defects (CHD) and to determine diagnostic evaluation limits in case of CHD. A single center database was retrospectively reviewed. Only fetuses having CHD of functional significance were included. Fetal cardiac anatomy was assessed on T2-weighted 3D multiplanar reconstructed images acquired using isovolumetric voxel size (0.3-0.8mm(3) ) that allows to visualize cardiac structures in situ in multiple fetal body planes. Cardiac pathology was classified into complex and isolated CHD. Based on clinically relevant findings pmMRI was considered either diagnostic or not diagnostic. A total of 24 fetuses were included in this study. The median gestational age (GA) was 22weeks and 2days (range 12w5d-34w6d). The median delay between delivery of the fetus and MR was 6hours30minutes (range 1h30min-19h). PmMRI was diagnostic for 12 out of 13 (92.3%) complex-CHD and for six out of eleven (54.5%) isolated-CHD. In case of valvular malformation a tentative diagnosis was reached in 7/11 cases (64%) based on indirect features. Postmortem MRI is a valid diagnostic tool for CHD in fetuses beyond 16 weeks up to term. This article is protected by copyright. All rights reserved.
    Full-text · Article · Mar 2014 · Prenatal Diagnosis

  • No preview · Article · Jan 2014 · American Journal of Obstetrics and Gynecology
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    ABSTRACT: Our aim was to analyze the apparent contraction of meshes in vivo after abdominal wall reconstruction and evaluate histological and biomechanical properties after explantation. Nine New Zealand female rabbits underwent repair of two full-thickness 25 × 30-mm midline defects in the upper and lower parts of the abdomen. These were primarily overlaid by 35 × 40-mm implants of a polyvinylidene fluoride (PVDF) DynaMesh (n = 6) or polypropylene meshes Ultrapro (n = 6) and Marlex (n = 6). Edges of the meshes were secured with iron(II,III) oxide (Fe3O4)-loaded PVDF sutures. Magnetic resonance images (MRIs) were taken at days 2, 30 and 90 after implantation. The perimeter of the mesh was traced using a 3D spline curve. The apparent surface area or the area within the PVDF sutures was compared with the initial size using the one-sample t test. A two-way repeat analysis of variance (ANOVA) was used to compare the apparent surface area over time and between groups. PVDF meshes and sutures with Fe3O4 could be well visualized on MRI. DynaMesh and Marlex each had a 17 % decrease in apparent surface area by day 2 (p < 0.001 and p = 0.001), respectively, which persisted after day 90. Whereas there was a decrease in apparent surface area in Ultrapro, it did not reach significance until day 90 (p = 0.01). Overall, the apparent surface area decreased 21 % in all meshes by day 90. No differences in histological or biomechanical properties were observed at day 90. There was a reduction in the apparent surface area between implantation and day 2, indicating that most mesh deformation occurs prior to tissue in-growth.
    No preview · Article · Jan 2014 · International Urogynecology Journal
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    ABSTRACT: With this pictorial essay we aimed to provide gestational age specific reference ranges of relevant fetal structures using micro- ultrasound, as well as its correlation with postmortem MRI and whole body sections. Time-mated pregnant rabbits (n = 24) were assessed once at various gestational ages in the second half of pregnancy (15, 17, 21-23, 25-28 and 30-31 days; term = 31 days). We obtained biometric data, together with Doppler flow patterns in the ductus venosus (DV), umbilical artery (UA) and umbilical vein. After euthanasia, micro-ultrasound images were compared with images obtained by 9.4 Tesla MRI and whole body paraffin sections at 15,23,26 and 28 days. We constructed biometric normative curves, which showed a significant correlation with gestational age. The pulsatility index (PI) in the UA decreased with gestation (PI = 5.746 - 0.2969(GA) + 0.004931(GA)(2) ; R(2) = 0.30), whereas pulsatility index for veins (PIV) in the DV remained constant (median PIV = 0.82 (0.60-1.12)). In this report we provide an anatomical atlas of fetal thoracic development using both micro-ultrasound and MRI. We describe anatomical fetal leporine development as can be visualized by micro-ultrasound and MR imaging. The reported reference ranges may be useful for researchers using the fetal rabbit model. This article is protected by copyright. All rights reserved.
    Full-text · Article · Jan 2014 · Prenatal Diagnosis
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    ABSTRACT: The intrarenal resistive index is routinely measured in many renal-transplantation centers for assessment of renal-allograft status, although the value of the resistive index remains unclear. In a single-center, prospective study involving 321 renal-allograft recipients, we measured the resistive index at baseline, at the time of protocol-specified renal-allograft biopsies (3, 12, and 24 months after transplantation), and at the time of biopsies performed because of graft dysfunction. A total of 1124 renal-allograft resistive-index measurements were included in the analysis. All patients were followed for at least 4.5 years after transplantation. Allograft recipients with a resistive index of at least 0.80 had higher mortality than those with a resistive index of less than 0.80 at 3, 12, and 24 months after transplantation (hazard ratio, 5.20 [95% confidence interval {CI}, 2.14 to 12.64; P<0.001]; 3.46 [95% CI, 1.39 to 8.56; P=0.007]; and 4.12 [95% CI, 1.26 to 13.45; P=0.02], respectively). The need for dialysis did not differ significantly between patients with a resistive index of at least 0.80 and those with a resistive index of less than 0.80 at 3, 12, and 24 months after transplantation (hazard ratio, 1.95 [95% CI, 0.39 to 9.82; P=0.42]; 0.44 [95% CI, 0.05 to 3.72; P=0.45]; and 1.34 [95% CI, 0.20 to 8.82; P=0.76], respectively). At protocol-specified biopsy time points, the resistive index was not associated with renal-allograft histologic features. Older recipient age was the strongest determinant of a higher resistive index (P<0.001). At the time of biopsies performed because of graft dysfunction, antibody-mediated rejection or acute tubular necrosis, as compared with normal biopsy results, was associated with a higher resistive index (0.87 ± 0.12 vs. 0.78 ± 0.14 [P=0.05], and 0.86 ± 0.09 vs. 0.78 ± 0.14 [P=0.007], respectively). The resistive index, routinely measured at predefined time points after transplantation, reflects characteristics of the recipient but not those of the graft. ( number, NCT01879124 .).
    No preview · Article · Nov 2013 · New England Journal of Medicine
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    ABSTRACT: A mathematical model to estimate membrane tensions (Mt) at the urogenital hiatus and midpelvis in patients with and without prolapse is proposed. For that purpose the complex structures of the pelvic floor were simplified and, based on assumptions concerning geometry and loading conditions, Laplace's law was used to calculate Mt. The pelvic cavity is represented by an ellipsoid in which the midpelvic and hiatal sections are described by an ellipse. The downwards forces within the pelvis (Fin) are in equilibrium with the support forces within its walls (Fw). Fin is the abdominal pressure (PABD) multiplied by the area A of the ellipse. The force inside the tissues (Fw) is distributed along the circumference of the ellipse C. The Mt can be approximated as Mt = (PABD.A)/C (N/m). Mt-α accounts for the angle α which describes tissue orientation with respect to the anatomical section and is calculated as Mt-α = Mt/sin(α). We conducted a retrospective study on archived magnetic resonance imaging scans (n = 20) and ultrasound images in patients with (n = 50) or without prolapse (n = 50) and measured actual geometrical variables. PABD was measured in patients with and without prolapse (n = 20). Mt at the urogenital hiatus at rest is 0.35 N/cm. They significantly increase with the Valsalva manoeuvre, by a factor of 2.3 (without prolapse) to 3.6 (with prolapse). Calculated Mt are much lower than what is reported for the abdominal cavity. Prolapse patients have significantly larger Mt, which during the Valsalva manoeuvre increase more than in healthy subjects.
    No preview · Article · Oct 2013 · International Urogynecology Journal
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    K Carels · F Claus

    Preview · Article · Sep 2013 · JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR)
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    ABSTRACT: Preclinical and histological data show overexpression of the type 1 cannabinoid receptor (CB1R) in prostate carcinoma (PCa). In a prospective study, the feasibility of 18F-MK-9470 positron emission tomography (PET) imaging in patients with primary and metastatic PCa was evaluated. Eight patients were included and underwent 18F-MK-9470 PET/CT imaging. For five patients with primary PCa, dynamic PET/CT imaging was performed over three acquisition intervals (0 to 30, 60 to 90 and 120 to 150 min post-injection). In malignant and benign prostate tissue regions, time activity curves of the mean standardized uptake value (SUVmean) were determined as well as the corresponding area under the curve to compare 18F-MK-9470 uptake over time. Muscle uptake of 18F-MK-9470 was used as reference for non-specific binding. Magnetic resonance imaging (MRI) was used as anatomical reference and for delineating intraprostatic tumours. Histological and immunohistochemical (IHC) examination was performed on the whole-mount histopathology sections of four patients who underwent radical prostatectomy to assess the MRI-based tumour versus benign tissue classification. For three patients with proven advanced metastatic disease, two static PET/CTs were performed 1 and 3 h post-injection. 18F-MK-9470 uptake was evaluated in bone lesions of metastatic PCa by comparing SUVmean values of metastases with these of the contralateral bone tissue. F-MK-9470 uptake was significantly higher in benign and malignant prostate tissue compared to muscle, but it did not differ between both prostate tissue compartments. IHC findings of corresponding prostatic histopathological sections indicated weak CB1R expression in locally confined PCa, which was not visualized with 18F-MK-9470 PET. Metastases in the axial skeleton could not be detected while some metastases in the appendicular skeleton showed higher 18F-MK-9470 uptake as compared to the uptake in contralateral normal bone. F-MK-9470 PET could not detect local PCa or bone metastases in the axial skeleton but was able to visualize metastases in the appendicular skeleton. Based on these pilot observations, it seems unlikely that CB1R PET will play a significant role in the evaluation of PCa.
    Full-text · Article · Aug 2013 · EJNMMI Research
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    ABSTRACT: In this manuscript we report 3 cases of severe lower urinary tract obstruction diagnosed before 20 weeks of pregnancy. All cases had a very similar prenatal presentation with a megacystis, bilateral hydro-ureteronephrosis and increased echogenicity of the kidneys. High-resolution postmortem magnetic resonance imaging (MRI), following termination of pregnancy, enabled accurate investigation of the underlying cause of the urinary tract obstruction, by depicting the presence of an urethral valve, urethral atresia and cloacal dysgenesis. Postmortem fetal MRI provides high anatomical detail and is very suitable to investigate congenital anomalies of the lower urinary tract. In case (timely or consented) conventional autopsy is not possible, MRI is an excellent alternative.
    No preview · Article · Jun 2013 · Fetal Diagnosis and Therapy

Publication Stats

522 Citations
268.97 Total Impact Points


  • 2008-2015
    • University of Leuven
      • • Department of Development and Regeneration
      • • Division of Radiology
      Louvain, Flanders, Belgium
  • 1970-2015
    • Universitair Ziekenhuis Leuven
      • • Department of Radiology
      • • Department of Gynaecology and obstetrics
      Louvain, Flanders, Belgium
  • 2008-2010
    • Universitair Ziekenhuis Ghent
      Gand, Flanders, Belgium